Sports impairment in youth with inflammatory bowel disease

Inflammatory Bowel Diseases

Each issue of Inflammatory Bowel Diseases® contains cutting-edge original basic science and clinical articles on diagnosis, treatment, and management of IBD from clinicians and researchers around the world.

Over 80,000 children and adolescents in the United States live with inflammatory bowel diseases (IBD), which includes Crohn’s Disease and Ulcerative Colitis. These are chronic autoimmune diseases that cause inflammation in the gastrointestinal tract. Crohn’s Disease can cause inflammation anywhere in the digestive tract, while the inflammation in Ulcerative Colitis is localized to the colon and rectum. Specific causes of IBD are unknown, but a combination of genetics, the environment, and the body’s immune response are factors that contribute to the development of IBD. IBD symptoms and disease severity often vary between patients, however, common symptoms include diarrhea, urgency to use the bathroom, abdominal pain, fatigue, fever, and weight loss. These symptoms can make it difficult for patients with IBD to exercise regularly. Among kids and teens with IBD, little is known about the impact of IBD symptoms on physical activity in youth with IBD. A recently published article on sports participation in youth with IBD by Dr. Rachel Greenley and colleagues provides us with key points to consider.

IBD symptoms including urgency to use the bathroom, diarrhea, abdominal pain, and fatigue can all can make it difficult for youth with IBD to be physically active. For youth with IBD, being concerned about exercising near a restroom, what their peers might think if they have to sit out of an activity, or pain related to IBD symptoms may make exercise difficult. In addition, IBD can lead to certain symptoms outside of the digestive tract, like joint pain, which can also make exercise difficult.

Why is physical activity an important topic to study in youth with IBD?

Physical activity is important for all youth as it helps promote better physical and mental health. Healthcare providers recommend that youth with IBD engage in the same amount of physical activity that healthy youth engage in, which is at least 60 minutes of daily exercise. Youth with IBD experience similar benefits of physical activity as healthy youth. Among adults with IBD, physical activity has been shown to help improve disease symptoms. Thus, youth with IBD who participate in regular physical activity may be healthier overall and experience additional benefits such as reduced IBD disease activity and decreased risk of osteoporosis. Additionally, youth with IBD may be at greater risk for developing a mental illness such as major depressive disorder. Thus, it is possible that for kids and teens with IBD, physical activity may also be beneficial in decreasing the risk of major depressive disorder.

Healthcare providers recommend that youth with IBD engage in the same amount of physical activity that healthy youth engage in, which is at least 60 minutes of daily exercise.

What percentage of youth with IBD experience impairment in sports?

Our study included a national sample of 450 youth with IBD between the ages of 12-17 years old. Overall, within the study sample, 66% of kids and teens reported that their IBD caused at least some interference with their ability to participate in sports. Moreover, 18% reported that their IBD caused a major impairment in their participation in sports. No differences in level of impairment in sports participation were seen between youth of different genders, ages, or races/ethnicities.

What disease or physical health characteristics influence participation in sports?

Youth with IBD that reported having a pouch, ostomy, or past IBD-related surgery experienced greater impairment in their ability to participate in sports. Additionally, youth with IBD that reported pain and fatigue were more likely to have impairment in sports participation. Finally, greater IBD disease activity was associated with greater impairment in sports participation. Disease activity, however, was most strongly associated with impairment in sports participation across all of these physical health characteristics.

What is the role of anxiety and depression in influencing participation in sports?

Youth with IBD that reported high levels of anxiety and depression were more likely to also have impairment in sports participation. However, when comparing the role of anxiety and depression to that of the physical health characteristics mentioned above, pain and history of IBD-related surgery were found to be more salient factors in influencing youths’ ability to participate in sports than anxiety or depressive symptoms.

Where do we go from here?

Future research should look at specific barriers to sports participation that youth with IBD experience, which will help identify strategies to enhance participation in sports. Future research should also follow youth over time to better understand if impairment in participating in sports is just a temporary issue or a long-term problem. Finally, future research is needed to understand other domains of physical activity that might be impaired in youth with IBD.

What are the clinical implications?

It may be helpful for healthcare providers working with youth with IBD to regularly evaluate the amount of exercise that is occurring within this group. For kids who are less active, healthcare providers could help youth identify barriers to physical activity. The healthcare provider could also assist in developing a plan for physical activity that is sensitive to the youth’s ongoing IBD symptoms and concerns. Additionally, healthcare providers could consider working with teachers and schools to advocate for accommodations that may make physical activity and sports participation easier for this population.

Rachel Neff Greenley, Ph.D. is an Associate Professor of Psychology and serves as the department chair at Rosalind Franklin University of Medicine and Science. Her research interests focus on youth and family adjustment in the context of pediatric chronic illness, with a particular interest in adherence and self-management skill development among adolescents with chronic illnesses. Dr. Greenley’s research has been funded by the Crohn’s and Colitis Foundation of America. She also teaches graduate level courses in Statistics, Health Psychology, and Child and Adolescent Cognitive Behavioral Therapy.

Jessica P. Naftaly, M.S. is a fourth-year clinical psychology doctoral student at Rosalind Franklin University working under the mentorship of Dr. Rachel Greenley. Her research and clinical interests are in health psychology, specifically the psychosocial aspects of chronic illnesses, adjustment to chronic illnesses (coping, social support, and stigma), transition readiness, adherence, and patient-provider communication. Jessica also serves on the Society for Health Psychology’s Student Advisory Council.

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